| NPI | 1871790949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAEL STEPHANIE MACLEOD Owner 813-288-8010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH6004) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 2314) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2012-08-20 |